Randomized Controlled HCC Screening Trial Not Feasible

And, US screening every three versus six months does not improve small liver cancer detection rate

WEDNESDAY, Dec. 7 (HealthDay News) -- A randomized controlled trial (RCT) of hepatocellular carcinoma (HCC) screening is not feasible for informed patients with cirrhosis; and small HCC detection is not improved by ultrasonographic screening (US) every three versus six months, according to two studies published in the December issue of Hepatology.

Hossein Poustchi, M.D., from the Tehran University of Medical Science in Iran, and colleagues evaluated the feasibility of running a RCT of HCC surveillance among patients with cirrhosis. Of the 205 patients informed about the screening risks and benefits, 99.5 percent declined randomization, and 88 percent of these chose nonrandomized screening, 10 percent chose standard care, and two patients were undecided. Among the 173 patients who chose nonrandomized screening and were followed-up for an average of 13.5 months, one received a liver transplant for liver failure, two died of nonliver causes, and three developed HCC.

Jean-Claude Trinchet, M.D., Ph.D., from Hôpital Jean Verdier in Bondy, France, and colleagues compared small HCC (≤30 mm) detection rates among patients with cirrhosis who received US either every six (Gr6M, 638 participants) or every three months (Gr3M, 640 participants). The two-year estimates of focal-lesion incidence were similar between the Gr3M and Gr6M groups (20.4 versus 13.2 percent; P = 0.067). However, the Gr3M participants had a significantly higher incidence of lesions ≤10 mm than the Gr6M patients (41 versus 28 percent). The two groups did not differ in HCC incidence or prevalence of tumors ≤30 mm in diameter.

"US surveillance, performed every three months, detects more small focal lesions than US every six months, but does not improve detection of small HCC, probably because of limitations in recall procedures," Trinchet and colleagues write.

Abstract - Poustchi
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Abstract - Trinchet
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